- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,413.10 / $19,054.61
| Facility | | $2,818.38 | $7,413.10 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,818.38 / $3,548.13
| Professional | | $2,290.87 | $2,818.38 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,090.30
| Facility | | $630.96 | $2,041.74 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $380.19 / $724.44
| Professional | | $363.08 | $380.19 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,818.38 / $7,762.47
| Facility | | $2,187.76 | $2,818.38 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,715.35 / $6,606.93
| Facility | | $2,454.71 | $3,715.35 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $18,197.01
| Professional | | $1,548.82 | $1,548.82 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,715.35 / $4,365.16
| Facility | | $3,311.31 | $3,715.35 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $2,187.76
| Professional | | $1,548.82 | $1,548.82 | $2,187.76 |